What’s Your Professional Opinion?

Massage Therapists tread a fine line. Recently, my 'professional opinion' was incorrect, reinforcing the important distinction between opinion & diagnosis. Please do not fear - no clients were harmed during the writing (or researching) of this article!

My writing is not always about motorbikes, honestly. But this past weekend a motorbike related incident has made me reflect about the remit of massage therapists and our limitations. Before I get to the good stuff, this has actually coincided with my review of our initial client consultation form that each new client is asked to complete.

What’s the story

It’s really important that a massage practitioner has a thorough understanding of their client’s medical history, including information about medication, previous accidents, lifestyle and postural habits. It really does help paint a picture of part of you, but only really works in conjunction with the actual consultation … the conversation. At the very end of the form, as it stands at the moment, are three statements with tick boxes. They read:

  • I understand that massage is not a replacement for medical care
  • I understand that no diagnosis will be made
  • I am responsible for paying for any appointment cancellation of less than 24 hours

For the purposes of this post, we can disregard the last point. It’s fairly self explanatory anyway - you cancel with little notice or don’t show up at all (this really does happen!), and we have very little chance of someone who does need the appointment being able to attend the gap.

“So, what’s your diagnosis?”

I hear this question quite a bit. I don’t like this phrasing, but I’m aware that when I’m asked this question, or “what do you think I’ve done?” or several other permutations, the client’s distinction is minimal. My typical response is “without peeling back a few layers and having a good look and poke around, there is no way of knowing. I’m sure you are aware that I can’t diagnose, but I can give you my best guess based on my massage experience.”

You see, massage practitioners can’t diagnose - we are not allowed to, it is WAY outside our remit. We are not provided any medical or clinical training. A physiotherapist can give a diagnosis, but then their training is at least three years undergraduate, two years post graduate. An osteopath undertakes a four or five year degree course, the same is true for a chiropractor. The massage course I did was a year long (well 10 months).

Having said all of that, I DO have four years of hands-on experience. I know from touch whether your muscles are grumpy or in spasm. I can’t diagnose the reason, but between us we can have a good attempt at guessing what is likely to have happened. But the deal with this is always a personal opinion with professional experience. NOT a diagnosis.

Post qualification

Passing a course, attaining a qualification is just the start. I remember one of my massage course tutors commenting that once you qualify you really start learning. Given the meltdowns I had on my course as I was struggling to learn the anatomy, physiology and pathology, I thought this was a mean thing to say. But it’s true. It was when I started to work with clients that I started to find learning easy. I could apply book knowledge to a client … it started to make sense. I’ve started being selective about the CPD courses that I will do each year. Yep, I love learning about all things body and massage.

Winter

Two seasons ago I had a snowboarding holiday. It was my first snowy holiday and was great fun. But it was hard work and it hurt. I had some big, hard falls and my non-medical self-diagnosis would be that I managed to give myself whiplash on at least three separate occasions. I did all the right things - had lessons, had body armour, including helmet, wrist guards and a seat protector, but my coccyx and head were zinging for several weeks and it took a good month to feel properly like me again.

Four wheels good, two wheels better

Several clients have commented on the dangers of riding motorbikes, given my work and business, but the thing is I’m passionate about riding. This weekend has highlighted that I am unlike to go snowboarding again. After all, whilst it was fun, I am not passionate about it, I don’t do it enough to really improve, and the chances of really hurting myself as I’m taking the time to learn are really quite high. It’s a shame, but I’m ok with that.

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But riding … This year I’ve done everything I can to build in time to ride. I have undertaken several courses to improve my knowledge and skill in the saddle. I took a full week off work to ride in Europe, and found an area of unsurpassed beauty that I long to return to and play in again. I have also done my first few track days, surrounded by knowledgable and passionate boys - even the very mature ‘grey’ ones are boys on bikes! - who turn up with one, two or a truck load (literally) of bikes to play on, and we go round and round and round. It is enormous fun, finding the line that works best, identifying the turning point, the … well I won’t bore you!

Which brings me back to this weekend.

The incident

Firstly, it wasn’t me. I’m not fast enough to have the kinds of problems that are usually associated with track day incidents. I’m very happy riding like a grandma, although admittedly I am getting faster. My boy has been riding for years, is very safe and fast. I have so much faith in his riding that I let him take my father out as a pillion passenger earlier this summer! But this Saturday it went wrong. I didn’t see it happen, but when I saw him, he was sitting up cradling his knee, or his wrist, I couldn’t decide which. But he was conscious, up and basically ok. It took a while to see the bike … they were not close to one another.

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Looking at the bike damage, looking at the data from the data logger, hearing the reports from witnesses, we know what happened, but we also know it was fast. So we know that he actually got very lucky. He’d hurt his hand which swelled and bruised quite quickly, but agreed he was ok enough to not wait 4.5 hours on a Saturday afternoon in A&E in South Wales. That evening we discussed what had happened and what we thought they’d find when we went on Sunday morning.

Massage Therapists can not diagnose

How his hand was immediately after his accident and how it appeared now suggested that he’d likely dislocated and then relocated his little finger. The swelling and bruising suggested to me that he’d also likely broken a bone in his hand, and our Sunday morning Minor Injury Unit trip proved that my anatomical guesswork wasn’t totally wrong as the x-rays confirmed that he’d broken his fifth metacarpal. But it also reinforced the fact that as a massage therapist I can’t diagnose. He has, in fact, broken his little finger near the knuckle. Because of the incredible swelling and bruising, it was suggested we return to the fracture clinic on Monday morning. Overnight, as the painkillers were wearing off, it also became clear that there is at least one broken rib.

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I started writing this post as we waited at the fracture clinic for him to be seen, and I’ve just had the news that the finger needs to be pinned. He needs an operation. Neither of us saw this coming. I certainly didn’t guess it was that serious.

Clients will continue to ask whether I know what they have done. I will continue to be happy to provide my personal opinion, backed up with my professional experience. But I will be even more attentive to ensure there is an understanding that this is exactly what it is. An opinion.

In the meantime, as the boy said, "at least this happened at the end of the season" ...